The present invention is a system and method for managing medical images. More specifically, it is a computer-based system and method for capturing, transmitting, storing, processing, and communicating electronic records associated with medical images.
Diagnostic imaging technology has evolved tremendously in the past twenty years, offering very sophisticated imaging tests such as magnetic resonance imaging (MRI) and computed tomography (CT). The MRI market in particular includes approximately 6,000 MRI machines in the United States, and 12,000 worldwide. Two-thirds of MRI devices in the US are located clinics and small hospitals. There are over 12,000 CT scanners in the United States and over 20,000 worldwide. Other significant medical imaging markets include for example, ultrasound, nuclear medicine, digital x-ray, and computerized radiology. On the aggregate, the potential medical image management market has been estimated at $5.5 Billion annually in the US and $12 Billion worldwide.
The need for immediate electronic delivery and convenient, economic storage of radiologic and other medical images and data has never been greater. The annual United States radiology market consists of more than 150 million x-rays, 100 million sonograms, 20 million MRI scans and 30 million CT scans performed by medical practitioners. The conventional process for managing medical images at most hospitals, clinics and imaging centers is as follows. The medical image is printed onto sheets of film, which are delivered to the radiologist for interpretation. After the transcribed report is delivered to the radiologist, reviewed for errors and signed, the films and report are delivered or mailed to the referring doctor. This process often takes several days, up to a week. If questions arise, the referring doctor contacts the radiologist, who may be forced to rely upon memory, having reviewed the films several days before and no longer has possession of them. Also, the referring doctor must then manage the hard-copy films, either by filing the films in his office, or returning the films to the imaging center or hospital to be filed, depending upon practices in the local community. If the patient then goes to a second doctor, requires surgery, or requires another medical imaging procedure, the films must be located and physically carried or shipped to the hospital, surgery center, or to the second doctor""s office. There are numerous opportunities for films to be lost or misfiled, and doctors who maintain more than, one office may not always have the correct patient films in the correct office.
The current film-based system is very expensive, and the charges for films, processing chemicals, and delivery can easily add up to $30 to $50 per MRI patient study. A typical MRI center scanning 300 patients per month has equivalent costs of approximately $12,000 per month ($40 per studyxc3x97300 patients/month). Other problems for the imaging facility are the numerous opportunities for the films to be physically lost, as well as the considerable time, personnel, and expense required for the delivery and retrieval of these films. Estimates are that up to 25% of medical images are not accessible when required.
Currently, no widely established commercial Internet solution exists for the digital delivery and archiving of the ever-increasing vast stores of radiologic data. Many patients are accustomed to sending email with various attachments, such as files or photos, and wonder why radiology images cannot be xe2x80x9cemailedxe2x80x9d to their doctors. However, several barriers exist for a medical image to be xe2x80x9cemailedxe2x80x9d to the doctor.
In order to electronically transport medical images efficiently, the images must be in a digital format. The imaging device, such as the MRI machine, must have the computer interfacing hardware and software configured to xe2x80x9cexportxe2x80x9d the data. A computer is needed to convert the proprietary image identification data (the header information) into a standardized format, such as DICOM (Digital Imagine, and Communication in Medicine). Also, the doctor who receives the images must have software that allows him or her to view the medical images and interpret the image header information (viewer). However, non-DICOM enabled models represent the majority of imaging machines. Due to financial constraints imposed by managed care on imaging centers, non-DICOM machines will continue to dominate diagnostic imaging for the foreseeable future.
When digital modalities such as CT and MRI first came into general clinical use, each manufacturer used its own proprietary means of reconstructing the data, formatting files and storing each of the studies. They did not share this basic information with other competing manufacturers; therefore, one set of images could not be communicated to another machine since each had a different format. In 1983, the American College of Radiology and the National Electronic Manufacturers Association met to discuss a standard. In early 1984 the two organizations formed the Digital Imaging and Communication in Medicine (DICOM) Standards Committee. After many years of extensive work, the first DICOM model was introduced in 1992. By late 1994, a few manufacturers had begun to offer to incorporate DICOM into their products, usually as an expensive ($20,000-$40,000) upgrade. However, even today, the majority of these manufacturers still today only incorporate DICOM in their new products for a significant extra charge ($20,000-$40,000). Many of the older established medical imaging systems do not even have a DICOM conversion available from the original equipment manufacturer. Whenever a DICOM conversion upgrade is available for already built and installed products, it is usually even more expensive than DICOM for a new product. DICOM is a communications standard and does not define particular hardware architecture. It permits integration of images into non-image databases and is the predominant standard for medical image communication. It enjoys broad support across specialties and other standards organizations throughout the world.
Interfaces have been developed to xe2x80x9cDICOM enablexe2x80x9d imaging systems that were not originally factory equipped with DICOM. Without supplying DICOM interfaces as a component of an overall system, a medical image management system in the general field contemplated by the invention would be required to take one of three courses of action: 1) limit their imaging center users to DICOM conformant equipment, 2) purchase or require their customer to purchase and install DICOM interfaces at a cost of upwards of $40,000, or 3) rely on a technique known as secondary capture. In the case of secondary capture methods, like video frame grabbing, some of the information is lost, because it only captures the 8-bit analog representation of the original 16-bit image pixel data. Also, secondary captured images cannot be later manipulated to the same degree as the original images. Because of the inherent drawbacks of secondary captured data, the American College of Radiology (ACR) standard states that the direct capture method is preferred for primary diagnosis.
It is not believed that the general imaging center and referring physician marketplace will tolerate the use of the inferior secondary capture method, or an ASP that can only connect to DICOM equipped imaging systems. The system and method of the present invention provides DICOM connectivity. Also, in order to transmit and store images without compromising the quality or integrity of the imaging data, an efficient medical image management system is preferably able to successfully connect disparate imaging equipment and systems without compromising the image quality. To accomplish this the system should be able to extract the proprietary data from various different imaging machines, again the vast majority of which are not DICOM enabled and therefore cannot xe2x80x9coutputxe2x80x9d the data in the DICOM format. Moreover, though DICOM is the universal industry standard, like the English language different xe2x80x9cdialectsxe2x80x9d of DICOM exist depending on how each of the many individual manufacturers xe2x80x9cspeakxe2x80x9d the DICOM language. What this means is that it is quite common for two systems that have DICOM interfaces to still have difficulty connecting and communicating with each other. Therefore, customization of interfacing, between such machines may be required in some circumstances.
Once these above barriers are overcome, it becomes possible to electronically transmit medical images in an efficient and readily adoptable manner. These electronic images, unlike film, can be simultaneously presented in multiple locations immediately after an imaging study is performed.
Picture Archiving and Communication Systems (PACS)
Various solutions have been developed with the intention of streamlining the storage and accessibility of medical images by managing, electronic records that include the images in electronic form that may be converted for viewing, such as on screen displays or via film printers.
One well-known type of such a system called xe2x80x9cPicture Archiving and Communications Systemsxe2x80x9d (PACS) generally provides medical image management via a collection of components that enable image data acquisition, transmission, display, and, storage. Such systems are implemented in imaging clinics and hospitals to make the digital data available at different locations within the radiology department or the facility. Further, the use of such systems is generally restricted to in-house radiology and other departments, thus excluding the referring physicians, who are outside the imaging facility. These systems have high price tags ($60,000 to $ 1,000,000) for the local installation of the respective central image management and storage systems generally required, and involve other high costs related to additional personnel to configure and maintain such image management systems locally onsite at the imaging facility.
Medical Images and Internet ASP""s
Because the medical image management market is so large, and represents such large volumes of recurring transmissions of electronic records associated with medical images, an ASP model for managing electronic images provides great potential for a highly profitable annuity business. Various efforts have recently been made to replace or at least significantly enhance the conventional film-based systems and methods for medical image management by managing these images electronically, and more particularly via an internet-based ASP model. However, the concept of an Internet based Application Service Provider (ASP) for the transmission and storage of medical images is an industry in its an embryonic stage. Very few, if any, of the over 300 diagnostic imaging procedures performed annually in the U.S. are being transmitted and/or stored utilizing an ASP model.
To transmit an image electronically as is intended with these known medical image management systems, the first step is to get the data from the imaging modality (CT, MR, ultrasound, etc.) to the image acquisition system at the customer site. There are two methods of obtaining this data: primary and secondary data capture. Because primary capture is not always possible in order to support other known medical image management systems and methods, they often use xe2x80x9csecondaryxe2x80x9d or xe2x80x9cindirectxe2x80x9d methods. The simplest and oldest xe2x80x9csecondaryxe2x80x9d capture method is often called xe2x80x9cframe grabbingxe2x80x9d. This method simply obtains the image present on the video monitor and records it. The resulting image is only 8 bits deep allowing 256 shades of gray, which means a significant amount of image data has been lost. The use of xe2x80x9cframe grabbingxe2x80x9d is also very labor intensive. When using xe2x80x9cframe grabbingxe2x80x9d, the technologists must pre-set the xe2x80x9cwindowxe2x80x9d and xe2x80x9clevelxe2x80x9d (brightness and contrast) of the image. This requires an excessive amount of the technologist""s time when compared to the more modem primary capture. These frame grabber systems work by taking the analog monitor output from a digital modality and running it through an analog-to-digital converter, which in itself degrades the data. The ability to adjust the brightness and contrast (window and level) of the image on the receiving end is also limited with images that were obtained using xe2x80x9csecondaryxe2x80x9d capture. Measurements and position location of the image, both extremely important to the physician, are not generally possible with acceptable accuracy using secondary capture. Furthermore, due to problems described above, the latest version of the American College of Radiology (ACR) standards for teleradiology effective Jan. 1, 1999, recommends compliance to DICOM and transfer of the full image data set, which is only possible with xe2x80x9cprimaryxe2x80x9d or xe2x80x9cdirect capturexe2x80x9d for primary diagnosis.
In general, most of the known systems and methods for managing medical images in electronic record format use xe2x80x9cpullxe2x80x9d type image delivery protocol which requires the referring physician to log on to a web server and then download his or her patient""s images. However, busy physicians do not have the time or the desire to access their patient""s images in this manner. The xe2x80x9cpullxe2x80x9d model requires the physician to log in as well as extensive physician input and time to initiate the data transfer. Additionally, the doctor must then wait for the image data to download.
Various more specific examples of such medical image ASP efforts are summarized in relation to respectively known companies in the general field as follows (much of the information provided immediately below is based upon information and belief, and in some cases is based only on rumor and verbal discussionxe2x80x94therefore the general and detailed elements for these companies may not be wholly accurate).
The following is a description of what is believed to be information related to a medical image management system to be provided by a company called xe2x80x9cAmicasxe2x80x9d. Amicas is a private company located in Newton, Mass. that is believed to market and sell software that allows radiology studies to be sent between Web servers. The target market for Amicas is believed to be large hospitals. It is believed that Amicas plans to enable the transfer of such images between any medical facilities that have standard e-mail systems, using UPS Document Exchange (SM)xe2x80x94an encryption-based secure delivery service featuring optional password protection, real-time racking and delivery confirmation. The physician still must login to get his or her email, and wait for the images to download. The company is currently using the service at 4 beta sites. The Company gained FDA approval in 1997. To qualify as a potential customer a client""s machines must have DICOM installed. CEO Dr. Adrian Gropper stated in an interview conducted May 2, 2000 at the E-Healthcare Conference in Las Vegas Nev. that Amicas has no plans to develop custom DICOM interfaces. Dr. Gropper has also stated that his company has no plans to offer any form of off site storage. It is further believed that the company uses lossy compression of the electronic records associated with medical images they manage. It is believed that Amicas has a test site which is located at the Loma Linda Veterans Administration Hospital.
The following is a description of what is believed to be information related to a medical image management system to be provided by a company called xe2x80x9ceMedxe2x80x9d. eMed is a private company located in Lexington, Mass. The target users are hospitals. The eMed.net service is believed to include a medical image viewing application with integrated access to medical images and reports along with other relevant information through a physician""s web site. eMed Technologies is a Healthcare Application Service Provider (HASP) and takes care of everything from server hardware, domain name registration, site creation and current content, all for a monthly subscription fee of $2,500. The company has FDA approval. The company prefers DICOM equipped machines, but is able to capture images from non-DICOM imaging machines in two ways: (1) DICOM converting device at a customer cost of up to $40,000; and (2) frame grabbingxe2x80x94a form of secondary capture which is believed to be unacceptable for primary diagnostic interpretation.
The following is a description of what is believed to be information related to a medical image management system to be provided by General Electric Medical Systems, Dallas, Tex. and Waukesha, Wis. stated in a press release dated Apr. 9, 2000 that GE will use an ASP model to primarily store data generated at an off-site location. It is believed that this recent announcement addresses an ASP model for GE""s traditional PACS system. The press release claims that GE will pilot the program during the summer of 2000. The press release does not mention numerous details (such as connectivity to their system i.e. whether non-DICOM compliant machines will ever be offered the service; whether only GE or non-GE equipment will be targeted; whether GE plans to develop any DICOM interfaces to non-DICOM equipment; what data specifically is planned to be stored). The press release mentions a network subscription fee arrangement but does not give any pricing details. Most importantly, GE does not deliver the images, but instead has the doctors log on.
The following is a description of what is believed to be information related to a medical image management system to be provided by Image Medical, a private company located in Palo Alto, Calif. The target market is large institutions. Image Medical uses an ASP model to transmit medical images over the Internet. The Image Medical system is called xe2x80x9cPractice Builderxe2x80x9d. It is DICOM compliant and works with existing PACS and provides the ability to access images and reports anywhere. xe2x80x9cPractice Builderxe2x80x9d includes a xe2x80x9cViewerxe2x80x9d for digital medical images, CT, MR, US, DR, CR and NM. The revenue model is an activation fee that covers connectivity, infrastructure and installation costs. A per transaction fee is then charged for image acquisitions, distributions and archival. The company is not developing interfaces for imaging machines that are not DICOM equipped.
The following is a description of what is believed to be information related to a medical image management system to be provided by a company called xe2x80x9cInphactxe2x80x9d, a private company located in Nashville Tenn. Inphact claims to integrate an Internet based ASP PACS with a RIS. The target market is any hospital or clinic that is unable to afford an in-house PACS. RadWeb(trademark) allows physicians to query radiology images 24/7 via the Internet. The company plans to extend its technology platform in the future to cardiology. The company is not believed to offer push technology, image history record system, or custom DICOM interfaces.
The following is a description of what is believed to be information related to a medical image management system to be provided by In Site One, Inc. which is located in Wallingford, Conn. The primary target market is hospitals. In Site One is a service provider offering digital image storage and archiving for the medical community. For this company, the imaging device must be DICOM compliant. xe2x80x9cIn Dexxe2x80x9d (Internet DICOM Express) is a transaction, pay as you go service for storage and archiving of DICOM images for hospitals. In Dex""s open architecture integrates with any PACS component as well as hospital networks and information systems. Images can be accessed via the Internet or through virtual private networks to a hospital""s network. In Dex is suited for facilities with or without PACS capabilities. For PACS owners, In Dex enables them to outsource the storage and archiving component. For non-PACS equipped facilities, In Dex delivers storage and archival of a PACS without the high capital outlay, maintenance costs, technical upgrades and staffing support. There is no delivery of images to referring physicians nor do referring physicians have access to view the images they order.
The following is a description of what is believed to be information related to a medical image management system to be provided by Radiology.com, which is located in Los Angeles, Calif. and Chantilly, Va. The target market is hospitals. Radiology.com announced the launch of a service that allows digitized medical images to be stored and retrieved on-line through a central, web-based repository on Mar. 9, 2000. The technology combines DICOM and JAVA that allows a high level of compression and encryption of medical images for transmission to a PC. The system employs an ASP model. The company claims open standards will allow lifetime access to a global central repository of medical images, named xe2x80x9cImage Bankxe2x80x9d. Patients can build their own imaging history through xe2x80x9cPatient""s Bankxe2x80x9d which can be used to obtain discrete second opinions. The revenue model is a pay-as-needed approach. It is believed that this system only exists on paper and no clinical sites have been developed.
The following is a description of what is believed to be information related to a medical image management system to be provided by xe2x80x9cReal Time Imagexe2x80x9d, a private company located in San Mateo, Calif. The target market is large hospitals with PACS. PACS on Demand is a product that allows physicians to view images anywhere, anytime, even over dial-up connections. iPACS is a Web server that integrates to PACS, allowing physicians to view images directly from a DICOM archive over the Internet using Microsoft""s Internet Explorer(trademark) or Netscape Navigator(trademark) Web-browsers. The user must install plug-in to his or her browser before attempting any use of this product. iPACS xe2x80x9cstreamsxe2x80x9d images on the fly using original image data without pre-processing or requiring separate archives.
The following is a description of what is believed to be information related to a medical image management system to be provided by xe2x80x9cStentorxe2x80x9d, a company located in the Silicon Valley. The target market is hospitals with existing Intranets. The Stentor system is PC based. Stentor""s xe2x80x9ciSYNTAXxe2x80x9d technology delivers images only over existing hospital networks. Stentor has FDA approval. Stentor claims its iSYNTAX system will integrate into any existing hospital network. Stentor can send real time images on as slow as a 1 megabyte per second network connection. Images are encoded using a wavelet technology. A lossless representation of the transmitted image is claimed; however, lossless transmission (as the present invention performs) is not claimed. Stentor claims no bills will be sent until real savings by the imaging department have been demonstrated. Stentor charges on a per use basis.
None of the other known electronic image management sytems and methods intended to provide an ASP model adequately address the needs of referring physicians and other parties in the healthcare provider stream outside of the imaging clinic.
In one regard, other systems intending to provide a medical image ASP service generally require timely log-on and download procedures at the physician terminal. In another regard, none of the other systems and methods intended to provide a medical image ASP are believed to provide the image center with a history record of where and when images are sent, received, and viewed. However, a system which pushes the images directly to remotely located desktops of interested healthcare providers or patients outside of the imaging clinic would be much more resource efficient at their end. Furthermore, medical imaging centers producing the electronic images would benefit from a system which provides them with a real-time, image history record with easily accessible information about the times and places that each image is sent, received, and viewed at all locations.
Also, other efforts intended to provide a cost-effective ASP generally require costly hardware investment, principally on the part of the respective imaging center, and according to some of these efforts per-use fees are charged for each image viewing occasion. However, smaller imaging clinics and healthcare providers outside of the imaging center would benefit from a business model which provides the associated image work-stations necessary to use the ASP without requiring capital expenditure on the hardware or software. These parties would be greatly benefited by a method that provides a medical image ASP on a monthly service fee only basis, without up-front hardware costs, and without costly xe2x80x9cper-usexe2x80x9d transaction fees. Moreover, by providing a medical image ASP that charges only the imaging clinics on a fixed fee basis, these centers would be able to solely enjoy the economic benefits of their increased revenues flowing from increased image volume, at least to the extent that such volume is charged through to payers. In particular, the imaging center would benefit from an electronic medical image ASP system that charges only fixed or per use fees, but that provides without direct capital expenditure a local image workstation at the imaging center (including in one aspect a DICOM conversion interface) for interfacing with the remotely located, central management system of the ASP. Other interested healthcare providers and patients outside of the imaging clinic would also greatly benefit from having access to a remote image viewing system for viewing and storing the electronic images available from the ASP, but without requiring them or the imaging center to pay for the viewing system.
The present invention provides a medical image management system and method that reduces the high financial cost, resource allocation, time, and unreliability associated with conventional production, transportation, and viewing of conventional film-based systems and methods.
The invention in another regard also provides a medical image management system and method that reduces the need for purchasing and/or managing sophisticated technology at medical imaging centers.
The invention also provides a medical image management system that directly addresses the needs of the referring physicians and other healthcare providers located outside of the imaging center and having interest in medical image studies.
The invention also provides a medical image management system and method that integrates diagnostic and other analytical software, algorithms, or other tools associated with medical images within one, central medical image management ASP.
The present invention also provides a medical image management system and method that pushes electronic records containing medical images to healthcare providers outside of the medical imaging center soon after the medical images are taken so that the healthcare providers may view the images without the need to remotely access a central image storage cite and find and download a specific, desired image for viewing.
The invention also provides a medical image management system and method that keeps a medical image history record of times and locations where electronic records containing medical images are pushed to and viewed by parties such as healthcare providers and patients outside of the medical imaging center, and that communicates the medical image history record to the medical imaging center which produces the image.
The invention also provides a medical image management system and method that transmits lossless or substantially lossless medical image records to healthcare providers outside of the medical imaging center without requiring the healthcare provider to spend a significant amount of time to access and view the associated medical images.
Accordingly, one mode of the invention provides a medical image management system that includes a medical imaging system, a local image workstation, and a central data management system. The medical imaging system produces an electronic record in a computer-readable format and that comprises an electronic image associated with a region of a patient""s body. The local image workstation communicates with the medical imaging system along a local interface such that the electronic record may be transmitted from the medical imaging device and received by, the local image workstation. The central data management system communicates with the local image workstation along a remote interface such that the electronic record may be transmitted from the local image workstation and received by the central data management system. The central data management system is also configured to push the electronic record to a pre-determined remote viewing system in a format such that the electronic record may be read and the electronic image converted to a recognizable, visible format.
According to one aspect of this mode, at least one of the medical imaging system, the local image workstation, and the central data management system is adapted to transmit the electronic record in a DICOM format. In another regard, the central data management system is adapted to receive and process the electronic record in a DICOM format.
According to a further aspect, in the event the medical imaging device does not produce the electronic record in a DICOM format, the local image workstation is adapted to convert the non-DICOM electronic record into receives into a DICOM format for transmission to the central data management system.
According to another aspect, the central data management system pushes the electronic record to the remote viewing station in a substantially uncompressed form with respect to the original size. In one more particular variation, the central data management system is adapted to push the electronic record to the remote viewing station without the electronic image being compressed more than about 3 times with respect to the original size. Further to an alternative embodiment, the central data management system pushes the electronic record to the remote viewing station with substantially lossless compression with respect to the original form and size. In another regard, the record is pushed with no loss. In still a further variation, there is at least about 1.5 times compression with respect to the original record size.
According to another aspect of this mode, the remote interface uses the internet. In another aspect, the remote interface uses a digital subscriber line (DSL) interface.
According to another aspect, the medical imaging device may be any one of the following: magnetic resonance imaging devices, CT scanner devices, ultrasound devices, computed tomography devices, nuclear medicine devices, and digital radiography or X-ray devices.
According to another aspect, each one, taken individually, or both of the central data management system and local image workstation have storage systems adapted to store the electronic record.
The system according to this mode may also further include a remote image viewing system that communicates with the central data management system along a second remote interface such that the electronic record is pushed from the central data management system and received by the remote image viewing system. The remote image viewing system may also have its own storage system which is adapted to store the electronic record. This aspect of the system may also further include an image history record system having a remote history record system associated with the remote image viewing system and a central history record system associated with the central data management system. The remote history record system sends a remote system message along the second remote interface to the central history record system and includes information related to at least one of: a time that the electronic record is received at the remote image viewing system, a time that the electronic record is opened at the remote image viewing system, and a time that the electronic image is viewed at the remote image viewing system. This image history record system may also in a further variation include a local history record system associated with the local image workstation, such that the central history record system is adapted to send a central system message along the second interface to the local history record system with at least a portion of the information contained in the remote system message.
According to still a further aspect of this mode, the central data management system comprises an internet-accessible applications service provider (ASP) with an application which is adapted to perform an operation based upon the electronic record that produces a result that is useful in managing the patient""s healthcare. In one variation, this application comprises a radiology information system (RIS) that is adapted to store healthcare management-related data with the electronic image as a part of the electronic record. In a further variation, the RIS stores healthcare billing-related information in the electronic record. In another further variation, the RIS stores time-based scheduling-related information associated with the patient""s healthcare in the electronic record.
Still another aspect of this mode includes a printer that is adapted to interface with at least one of the medical image system, local image workstation, or central data management system and which is adapted to print a recognizable, visible film associated with the electronic image.
Another mode of the invention provides a medical image management system with a medical imaging means, an image storage means, and an imaging pushing means. The medical imaging means is located at a first location and is for producing an electronic record in a computer-readable format and that includes an electronic image associated with a region of a patient""s body. The pushing means pushes the electronic record along a remote interface to a remote image viewing system at a second location that is remote from the first location. Further to this mode, the electronic record is pushed in a format that may be opened such that the electronic image may be converted into a recognizable, visible format.
One aspect of this mode also provides a viewing means associated with the remote image viewing means for viewing the electronic image at the second location. Another aspect also provides means for providing information related to the patient in the electronic record. Yet another aspect provides a DICOM conversion means for converting the electronic record from a non-DICOM format to a DICOM format. Still a further aspect of this mode provides an image history record means for maintaining an image history record related to at least one of the transmission of the electronic record, the receipt of the electronic record, and the viewing of the electronic image. In one regard, this image history record means maintains an image history record related to each of the transmission of the electronic record, the receipt of the electronic record, and the viewing of the electronic image. In one highly beneficial variation, the image history record means includes: means for centrally managing the image history record at a central data management system located at a third location which is remote from the first and second locations; means for communicating the image history record from the central data management system to a local image workstation at the first location; and means associated with the local image workstation at the first location for displaying the image history record.
Another aspect of this mode provides DICOM conversion means for converting the electronic record from the medical imaging means into a DICOM format.
Further to another highly beneficial and desirable aspect of this mode, the image storing means includes a local storage means, a remote storage means, and a central storage means. The local storage stores the electronic record at the first location. The remote storage means stores the electronic record at the second location. The central storage means stores the electronic record at a third location that is associated with a central data management system and that is remote from the first and second locations. In one more detailed variation of this multi-storage aspect, the central storage means comprises a back-up storage means for storing the electronic record at a fourth location that is remote from the first, second, and third locations.
One further aspect of the pushing means according to this mode includes a local pushing means and a central pushing means. The local pushing means is at the first location and pushes the electronic record to a central data management system at a third location which is remote from the first and second locations. The central pushing means is associated with the central data management system at the third location and pushes the electronic record from the third location to the remote image viewing system at the second location.
Another further aspect of the pushing means according to this mode includes a central data management system at a third location that is remote from the first and second locations. The central data management system receives the electronic record from the first location and pushes the record to the remote image viewing system at the second location.
According to still a further aspect of this mode, a display means associated with the remote image viewing system displays the electronic image in a recognizable, visible format at the second location.
Another mode of the invention provides a medical image management system with a local image workstation, a central data management system, and a remote image viewing system, all respectively configured and networked such that the local image workstation pushes the electronic record via the central data management system to the remote image storage system. More specifically, the local image workstation communicates with a medical imaging system along a local interface at a first location. The local image workstation receives an electronic record that includes at least in part an electronic image from the medical imaging system associated with a body of a patient. The central data management system communicates with the local image workstation along a first remote interface from a second location that is remote from the first location, such that the central data management system receives the electronic record from the local image workstation. The remote image viewing system communicates with the central data management system along a second remote interface from a third location that is remote from the first and second locations. The remote image viewing system has a remote image storage system adapted to store the electronic record in a computer readable format, and is adapted to open the electronic record from the remote image storage system and to convert the electronic image into recognizable, visible form.
According to one aspect of this mode, the central data management system has a central image storage system that is adapted to store the electronic record in a computer-readable format. In one further variation, the central image storage system includes a back-tip storage system that is adapted to store the electronic record in a computer-readable format at a fourth location.
In another aspect of this mode, the local image workstation includes a local image storage system that stores the electronic record.
According to another aspect, the system further provides an image history record system associated with at least one of the local image workstation, central data management system, and remote image viewing system. This image history record system maintains an image history record that contains history information related to at least one of locations where the electronic record has been sent, locations where the electronic record has been received, times when the electronic record has been sent to a location, times when the electronic record has been received at a location, times when the electronic record is opened at a location, and times when the electronic image is viewed at a location.
One more variation of this image history record system according to the present mode also provides a remote history record system associated with the remote image viewing system, and a central history record system associated with the central data management system. The remote history record system sends a remote system message from the remote image viewing system to the central history record system and which contains the history information related to activity at the remote image viewing system. The central history record system sends a central system message to the local history record system and which contains at least a portion of the history information contained in the remote system message. In a further more detailed variation the local image workstation is configured to display the history information.
Another mode of the invention is a medical image management system with a medical imaging system, a local image workstation, and means for pushing the electronic image to a remote image viewing, system in a format such that the electronic record may be converted in order to represent the electronic image in a recognizable, visible format.
The medical imaging system produces the electronic record that comprises an electronic image associated with a region of a patient""s body in a computer-readable format. The local image work-station communicates with the medical imaging device such that the electronic record may be transmitted from the medical imaging device and received by the local image workstation.
One aspect of the pushing means according to this mode further includes a central data management system, local pushing means for pushing the electronic record from the local image workstation to the central data management system, and remote pushing means for pushing the electronic record from the central data management system to the remote image viewing station.
According to another aspect, the system further includes means for displaying the electronic image at the remote image viewing system.
According to still a further aspect, the system also includes a means associated with the central data management system for processing, the electronic image in order to produce a result that is useful in the patient""s healthcare management. This processing means in one highly beneficial variation includes Alzheimer""s diagnostic analysis of the electronic image. Another highly beneficial variation includes MR spectroscopy application to the electronic image.
Another mode of the invention provides a medical image management system with a particular central data management system. The central data management system includes a computer which communicates with an electronic transmission means along a first remote interface and electronically receives an electronic record from the electronic transmission means that includes an electronic image associated with a region of a patient""s body. The computer also communicates with a remote image viewing system along a second remote interface and pushes the electronic record in a DICOM format to the remote image viewing system.
According to one aspect of this mode, the system also includes a local image workstation that communicates with a medical imaging system that produces the electronic image along a local interface at a first location. The central data management system communicates with the local image workstation along a remote interface from a second location remote from the first location in order to receive the electronic record from the local image workstation. In one more detailed variation, the local image workstation transmits the electronic record, and the central data management system receives the electronic record, in the DICOM format.
According to another aspect of this mode, the central data management system is associated with an image history record system that maintains an image history record with information related to at least one of: locations where the electronic record has been sent from the central data management system, locations where the electronic record has been received from the central data management system, times when the electronic record has been transmitted from one location to another location, times when the electronic record has been received at one location from another location, times when the electronic record is opened at a location, and times when the electronic image is viewed at a location.
Another aspect of this mode includes a storage system associated with the central data management system and which stores the electronic record in at least two relatively remote locations.
Another mode of the invention is medical image management system with a local image workstation which communicates with a medical imaging system along a local interface in order to electronically receive an electronic record from the medical imaging system that includes an electronic image associated with a region of a patient""s body. The local image work-station also communicates with a central data management system along a remote interface in order to push the electronic record to the central data management system. The local image workstation is also adapted to receive and display a message from the central data management system related to an image history record with history information that related to at least one of: locations where the electronic record has been sent from the central data management system, locations where the electronic record has been received from the central data management system, times when the electronic record has been transmitted from one location to another location, times when the electronic record has been received at one location from another location, times when the electronic record is opened at a location, and times when the electronic image is viewed at a location.
Another mode of the invention is a method for managing medical images. The method includes in one regard receiving along a first remote interface an electronic record, which includes an electronic image that is associated with a body of a patient, from a medical imaging system located at a first location and at a central data management system located at a second location that is remote from the first location. The method further includes pushing the electronic record from the central data management system along a second remote interface to a remote image viewing system located at a third location that is remote from the first and second locations.
One aspect of this mode further includes transmitting a central system message from the central data management system and to the local image workstation, wherein the central system message transmitted includes history information that comprises at least one of: locations where the electronic record has been sent from the central data management system, locations where the electronic record has been received from the central data management system, times when the electronic record has been transmitted from one location to another location, times when the electronic record has been received at one location from another location, times when the electronic record is opened at a location, and times when the electronic image is viewed at a location.
Another aspect of this method mode further includes receiving the electronic record at the remote image viewing system and opening the electronic image at the remote image viewing system, wherein the history information comprises the time and location of the receiving and viewing of the electronic image at the remote image viewing system. This aspect also includes communicating the history information from the remote image viewing system and to the central data management system via a remote system message before sending the central history message from the central data management system to the local image workstation.
Still another aspect of this method mode includes applying an application to the electronic image using the central data management system, wherein the application produces a result that is useful in the patient""s healthcare management. The method according to this aspect further includes attaching the result to the electronic record to form a supplemented electronic record, and transmitting the supplemented electronic record from the central data management system to at least one of the local image workstation and the remote image viewing system. One particular beneficial variation of this aspect includes using an application that produces a result useful in diagnosing a parameter associated with Alzheimer""s Disease. Another variation includes applying an MR spectroscopic analysis of the electronic image.
Another aspect of this mode includes pushing the electronic record from the central data management system to the remote image viewing system in a DICOM format.
Still a further aspect includes pushing the electronic record to the remote image viewing system without substantially compressing the electronic image.
Yet another aspect includes pushing the electronic record to the remote image viewing system after performing substantially loss-less compression to the electronic image.
The systems and methods of the invention for managing medical images electronically over remote interfaces such as via the internet also allow for a highly economical method for providing a medical image management ASP in a manner that expands the bottom line for medical imaging centers in particular. Therefore, the invention also includes various modes associated with the economical cost-flow related to the implementation and use of the medical image management sytems of the invention.
Another specific mode of the invention therefore is a method for providing medical image management system. The method provides a local image workstation that communicates with a medical imaging system managed by a medical imaging center along a local interface at a first location. The local image workstation is configured to receive multiple electronic records from the medical imaging system each comprising at least one electronic image that represents at least a portion of a patient""s body. The method also provides a central data management system that communicates with the local image workstation along a remote interface from a second location that is remote from the first location. The method also provides a remote image viewing system that communicates with the central data management system along a second remote interface from a third location that is remote from the first and second locations. Once the local image workstation, central data management system, and remote image viewing systems are installed and interfaced, the method further includes pushing the electronic records from the local image workstation to the remote image viewing system via the central data management system and along the first and second remote interfaces.
Further to this mode, the prior recited steps are performed while charging only the medical imaging center a pre-determined, fixed, periodic fee for the pushing of the electronic records through the central data management system regardless of the volume of electronic records pushed per modality. The party responsible for receiving the images at the remote image viewing system is not charged for the viewing system, which is generally downloadable, or for the receipt of the images. The imaging center is not charged for the local image workstation or for the transmission of any given image in a direct way. Regardless of how many images are sent via this system, or to how many places, the imaging center pays the same
One aspect of this mode further includes providing a communication link for the first and second remote interfaces with the central data management system via an IP address associated with the central data management system on the internet.
Another aspect of this mode further includes providing the remote image viewing system at least in part by providing software that is downloadable over the second remote location onto a computer at the third location. In one particularly beneficial variation of this aspect, the software may be downloaded free of charge.
According to another aspect, the local image workstation comprises a computer, and the local image workstation including the computer is provided to the medical imaging clinic for use in the medical image management system without directly charging the medical imaging clinic for the local image workstation.
Still further to another aspect, the method also includes providing a medically useful diagnostic application on the central data management system that is adapted to perform a diagnostic operation on the electronic image at the central data management system to produce a medically useful result, and communicating the result to at least one of the local image workstation or the remote image viewing system in a computer readable form, wherein the result is provided without directly charging the medical imaging clinic or a user operating the remote image viewing system on a per-use basis of the diagnostic application.
An alternative embodiment of the invention provides a polling system located with the remote workstation, viewer or system. The polling system is an automated system within the remote workstation or viewer that polls the central data management system for queued data. The polling system may poll the central data management system on a preset schedule or periodic basis. It may also poll for data upon occurrence of a predetermined triggering event. Such events may, for example be booting the computer, a predetermined log in, establishing or re-establishing an internet connection, detecting a change in an assigned IP address.
The polling system includes: an IP address identifier, IP address notifier, a data request device and an internal poller. The IP address identifier internally determines the connection status and IP address, e.g., assigned by an internet service provider. The IP notifier, after proper authentication, notifies the central database of the current IP address. The data request device requests queued data from the central data management system. The internal poller polls the viewer, workstation or system for the occurrence of a predetermined event that triggers the IP address notification and/or data request.
In variation of this embodiment, the polling system is provided with the image push system that uses push technology as described above. According to this embodiment, the polling system will notify the central data management system of the image system, workstation or remote viewer""s IP address. The central data management system will store the last known IP address in its database, for example, in a look up table. When the central data management system receives an image or other data, it will attempt to push the image or other data to the last known IP address of the specified remote location. The central data management system pushes data to locations over the Internet using push technology known to one of ordinary skill in the art, in the unique medical image delivery application and system described above with respect to FIGS. 1-6. If the delivery fails after a predetermined number of attempts, the data will be placed in a queue in the central data management system with a destination identifier that identifies the intended recipient. The central data management system delivers the queued data to the remote location when the remote module""s polling system notifies the central data management system of the its current IP address or when the polling system requests delivery of queued data.
The data delivered by the central data management system may be the image itself or related information, for example, the review history, radiologist or physician notes, text, voice-overs, time, date and person reviewing the images, comments, instructions, as well as other information relating to diagnosis, treatment or the patient""s medical record.
Another aspect of the invention provides an internal polling system within the local image station for communicating IP address information to the central data management system. Accordingly, in a similar manner, the local system will update its IP address information and request queued data stored in the central data management system. The central data management system will then send queued data such as information concerning delivery and review status of the delivered medical image, to the local system.
In one embodiment, the polling system within a particular module sends a signal to the central data management system when a particular event has occurred. The signal may either update the IP address and/or request queued data that was not successfully delivered to the module. The event may be, e.g., turning on the system, rebooting the system, connecting to the internet, reconnecting to the internet, internet server IP address reassignment or the expiration of a preset time interval. In this regard, the module""s internal software may be structured so that when the module is turned on or booted, the execution program includes sending a signal to the internal poller that an event has occurred. Alternatively, the programming may directly instruct the notification and request device to update the IP address or request queued data from the central data management system. Additionally, the software may be structured to conduct periodic internal polling for changes such as IP address change or loss of Internet connection. For example, the IP address may be identified and stored in a file. Periodically, the stored address will be compared with the current IP address identified to the module to determine if a change has occurred. Such programming may be accomplished by way of computer programming techniques generally known in the art.
The polling event may be the passing of a predetermined time interval. For example, on a periodic basis, the polling system may check the central database for queued data and/or may update the central database""s look up table containing IP addresses.
The central data management system tracks delivery attempts and maintains a database of such attempts, successes and failures. As described above, the central data management system stores the images and any associated data including delivery and access information, whether originating from a local system, remote system or the central data management system.
The polling system of the present invention provides efficient image delivery to locations or modules that do not have static IP addresses. The system is compatible with more economical, dial-up Internet services. If, for example, an Internet server is designed to switch or change IP addresses during a session, the change in IP address may be updated in the central database.